Consider colonoscopy for young patients with hematochezia

BACKGROUND: Hematochezia is a common complaint in adult patients aged <50 years. Most studies of lower endoscopy for rectal bleeding have concentrated on older patients or have failed to mention the location of lesions. OBJECTIVE: To determine the findings of complete colonoscopy in adults younger than 50 years with rectal bleeding. METHODS: Data were retrieved from medical records and included demographics, indications, endoscopic findings, and histology. Lesions were labeled according to location: proximal to the splenic flexure or distal to (and including) the splenic flexure. Excluded were those with a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer. RESULTS: The study included 223 patients with rectal bleeding aged <50 years who had undergone a colonoscopy. Normal findings were recorded for 48 (21.5%). Four (1.8%) were diagnosed with cancer in the distal colon, and 22 (9.9%) were found to have colon adenomas, 6 of whom had proximal adenomas only. Hemorrhoids were present in 135 patients (60.5%). Other findings included colitis, angiodysplasia, diverticulosis, anal fissures, and rectal ulcers. CONCLUSIONS: Colon neoplasms may be present even in younger adults with nonurgent rectal bleeding. Though most findings were benign and located in the distal colon, colonoscopy should be strongly considered for this patient group.     

Views of doctors in training on the importance and availability of career advice in UK medicine

OBJECTIVES: To determine whether doctors in their first year after qualification wanted career advice, and, if so, whether they thought they had been able to obtain useful advice, and whether older doctors thought that adequate career advice had been available to them. METHODS: We carried out a postal questionnaire survey of all UK medical graduates of 1988, 1993, 1996, 1999 and 2002, and a 25% random sample of the graduates of 2000. RESULTS: The response rate was 67.4% (24 261/35 976 mailed questionnaires). Of doctors in the first postgraduate year, 95% agreed that: 'It is important to be given career advice at this stage of training.' A total of 38% disagreed with the statement: 'I have been able to obtain useful career advice since graduation.' Of more experienced doctors surveyed between 3 and 11 years after graduation, 34% agreed that: 'Making career choices has been made more difficult by inadequate career advice.' CONCLUSIONS: The great majority of junior doctors want career advice after qualification. It cannot be assumed that they are able to seek it out for themselves satisfactorily. Career advice needs to be planned into postgraduate work and training.     

Why do older people not get immunised against influenza? A community survey

Many older people who would benefit from influenza vaccine do not get immunised. We carried out a postal questionnaire survey of people aged 65 years and over living in the community to explore views about influenza vaccine and identify ways of improving uptake. Completed questionnaires were returned by 1468/2553 (57.5%). Vaccine coverage for 1998-1999 season was 50.5% (95% confidence interval (CI) 47.9-53.1%). Important predictor variables for non-uptake included absence of medical risk factors, perceived good health, lack of advice from a doctor or nurse, and negative views on vaccine efficacy and safety. Most people had to request vaccination, only one in five got a reminder from their general practitioner. There is scope for improving influenza vaccine coverage in older people by placing more emphasis in patient information materials on vaccine efficacy and safety and by greater use of reminders.     

Australian parents’ use of universal child and family health services: A consumer survey

This study aimed to explore Australian parents’ use of universally available well‐child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well‐child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.     

Use of CAM results in delay in seeking medical advice for breast cancer

Cancer patients in developing countries often delay seeking medical advice. It can adversely influence the clinicopathological behavior and outcome of the disease process. This study was undertaken to obtain information about initial perceptions of patients presenting with breast lump, subsequent efforts to seek medical advice, frequency and reasons for delay in seeking medical advice and its possible impact on clinicopathological characteristics. We prospectively gathered data from 138 recently diagnosed (3 months) breast cancer patients who had initially presented with a breast lump and were referred to the medical oncology service for further treatment. Delay in seeking medical advice was defined as time period of 1 month between initial perception of lump and first physician visit. The study was conducted at the National Cancer Institute, Karachi, Pakistan. Most (85%) patients discovered the lump accidentally. In other cases, lump was discovered by the family physician or by the patient as part of regular self-examination. Etiologic perceptions included malignancy (17%), benign growth (26%), milk clot (19%), trauma (23%) and infection (10%). On average, patients took 8.7 weeks to inform the family and 17.2 weeks to first physician visit. Fifty three percent delayed seeking medical advice. Common reasons were; antecedent use of complimentary/alternative therapies (34%), lack of significance attached to the lump (23%), fear of surgery (22%), conflicting personal commitments (7%), fear of cancer (5%), and others (8%). Twenty nine percent practiced CAM before visiting any physician. Common methods used were homeopathy (70%), spiritual therapy (15%) and Ayurvedic medicine (13%). CAM use was associated with delay in seeking medical advice (OR: 5.6; 95% CI: 2.3, 13.3) and presentation at an advanced stage of disease (OR: 2.2; 95% CI: 1.01, 4.6). Patients who delayed seeking medical advice more often had positive axillary nodes and stage III/IV disease. Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process.     

L’effet du non-recours aux soins médicaux et dentaires sur les dépenses de santé des personnes ayant une maladie chronique

BackgroundPeople with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease.MethodsWe conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010–2013).ResultsPeople who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease.ConclusionThe lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.     

Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.     

北京、上海社区老年人跌倒现况及影响因素研究

目的 了解北京、上海两城市社区老年人跌倒发生的现况,分析社区老年人跌倒发生的危险因素,为开展老年人跌倒的预防工作提供理论依据。方法 采用多阶段整群随机抽样,分别抽取北京市的4个小区和上海市的6个小区,对其中≥60岁的老年人进行入户调查。结果 接受本次调查并完成全部问卷的老年人共1 345人,2014年内共有342人发生过跌倒,共发生478次,跌倒发生率为35.54%,跌倒的地点主要在家中,占45.61%。多因素分析结果显示,跌倒发生的影响因素主要有:年龄,易导致跌倒发生的相关疾病,能否正确认识自己的能力,鞋子是否合脚防滑,楼梯台阶高度、坡度是否合适。结论 北京、上海两地跌倒发生率较高,跌倒主要发生在家中。为了降低老年人跌倒发生率,应该从个人、家庭、社区等各个方面针对高危人群进行综合性的干预措施。     

新型冠状病毒肺炎公众防护意识与行为调查分析

目的 了解新型冠状病毒肺炎(新冠肺炎)的公众防护意识及行为情况.方法 自行设计调查问卷,于2020年2月15-22日采用方便抽样的方法对来到、返回或居住在江苏省≥15岁居民进行新冠肺炎防控知识及其影响因素调查.采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对居民新冠肺炎防护知识得分影响因素进行分析.结果 共...     

江苏省中老年人牙周健康状况调查

目的了解江苏省中老年人牙周健康流行状况，为开展中老年人口腔预防保健提供基线资料。方法参考世界卫生组织（WHO）《口腔健康调查基本方法》（第4版）调查方法，采用多级抽样，调查江苏省35～44岁和65～74岁2个年龄组的城乡居民1584人，男女各半，城乡人数各半。结果城乡居民牙周健康、牙龈出血、牙结石、浅牙周袋和深牙周袋的检出率与平均区段数分别为8．05％与1．62、61．27％与1．50、84．45％与3．64、32．07％与0．56和7．46％与0．10。65～74岁年龄组牙周袋检出率和平均区段数高于35～44岁年龄组（P〈0．01）。牙周附着丧失记分为2、3、4的检出率和平均区段数均为65～74岁组高于35～44岁组（P〈0．01）。结论牙周病是江苏省中老年人常见病、多发病，牙结石是中老年人口腔卫生面临的一个重要问题。因此，应加强牙周病的预防工作，开展社区口腔卫生服务，提高居民口腔健康水平。     

#68 Is there a true “shift” to the right in the incidence of colorectal cancer?

PURPOSE: A recent “shift” in the incidence of colorectal cancer (CRC) to right-sided colon cancers has been reported. Whether this “shift” resulted from a true increase in the incidence of right colon cancers or decline in left colon cancers is unknown. To disentangle these potential explanations, we examined temporal trends in proportion of right colon, left colon, and rectal cancers as well as incidence rates.METHODS: Using data from the NCI SEER program, proportions and age-adjusted incidence rates were calculated for right colon, left colon, and rectal cancers by race over three-year time periods from 1978–1998. Proportion of cases by age at diagnosis was also calculated.RESULTS: Although the proportion of individuals diagnosed with right colon cancer increased for whites (1978–1980 = 34%;1996–1998 = 40%) and blacks (1978–1980 = 37%;1996–1998 = 44%), the proportions with left colon and rectal cancers decreased. Between 1978–1998, age-adjusted incidence rates of left colon cancer declined in whites (1978–1980 = 16/100,000; 1996–1998 = 13/100,000) and blacks (1978–1980 = 18/100,000;1996–1998 = 12/100,000, while the incidence rates of right colon cancer (1978–1980 = 14/100,000;1996–1998 = 15/100,000) did not change significantly. Age-adjusted incidence rates of rectal cancer remained stable for blacks (10/100,000) and declined for whites (1978–1980 = 15/100,000; 1996–1998 = 12/100,000). Overall, 43% of individuals >60 years diagnosed with CRC had right colon cancer. Smaller proportions were diagnosed with left colon (31%) or rectal cancer (26%). Conversely, among individuals <60 years, 28% had right colon, 34% left colon, and 38% rectal.CONCLUSION: 1) The “shift” to right colon cancer is due to a decline in the incidence of left colon and rectal cancers, while the incidence of right colon cancers remains unchanged. 2) In the elderly, the majority of colon cancers are found in the right colon. This has important implications for choice of screening method used in the elderly.     

A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men

OBJECTIVE: To assess the prevalence of chronic post-vasectomy testicular pain (CPTP) compared to the prevalence of chronic testicular pain in a control population of non-vasectomised men. METHODS: A retrospective postal study of 198 men who had a vasectomy more than 3 years previously at the Palatine Centre to determine the incidence of CPTP, of whom 101 (51%) replied (mean age 40.4 years, range 29-54 years, mean time since vasectomy 46.5 months). A control group of 102 men (mean age 40.2 years, range 28-55 years) who had not had a vasectomy were obtained via patients attending the community family planning clinics or associated general practitioner (GP) services in the same geographical area. RESULTS: Occasional non-troublesome discomfort was reported by 37/101 of the post-vasectomy men compared to 21/102 of the control group. Occasional discomfort which was a nuisance was felt by 10/101 of the post-vasectomy group compared with 3/102 of the control group, and 6/101 in the post-vasectomy group reported pain severe enough to seek medical advice compared to only 2/102 controls. None of the post-vasectomy men regretted having had the operation. CONCLUSIONS: Only 6% of cases (compared to 2% of controls) experienced pain severe enough to seek medical advice in the 3-4-year post-operative period. However, there was a significant difference in the prevalence of occasional testicular discomfort between post-vasectomy men and controls. Mostly these pains were not regarded as troublesome, however men attending for vasectomy counselling should be informed of the possibility of this morbidity.     

“健康中国”背景下某市中老年居民就医方式及其影响因素研究

目的了解某市中老年(40岁以上)居民医疗需求、利用现状和患病后就医方式,探讨影响就医方式选择的因素,以期引导中老年居民形成正确的就医模式。方法采用多阶段分层随机抽样方法将某市6个行政村(居委会)766名年龄≥40岁的户籍居民作为调查对象,通过问卷调查收集数据,描述中老年居民卫生服务需求及利用现状、患病后就医方式选择行为并分析及其影响因素。结果中老年居民慢性病患病率为74.5%,两周患病率为47.7%,两周就诊率为12.5%,两周患病就诊率为26.3%。患病后有161人选择医院就诊(21%),有455人选择自我医疗(59.4%),有150人选择不做任何治疗(19.6%)。经无序多分类Logistic回归分析发现,婚姻状态、体检、健康档案、获取健康知识频率和医疗类型偏好等因素影响着中老年居民的就医方式。结论中老年居民卫生服务需求量较大但卫生服务利用率不足,患病不就医现象严重,急需采取有效措施引导居民合理就医。     

The Incidence and Outcome of Rectal Bleeding in General Practice

The objective of the studies reported in this paper was to determinethe incidence as well as the final diagnostic outcome of rectalbleeding presenting in general practice. Because of the widevariety observed in incidence rates among 83 general practitioners(GPs) in the first study (A) an additional study (B) was undertaken.In study B with 10 GPs special efforts were made to maximizethe catchment rate. The mean ‘consultation incidence rate’was 7 per 1000 people per year. A follow-up period of at least1 year was applied to establish the final diagnostic conclusion.Occurrence of colorectal cancer was found in 3% of patientswith rectal bleeding. This may represent an overestimation ofthe prior probability since there was a selection in favourof patients with clinically relevant rectal bleeding. In about90% of patients rectal bleeding was related to minor ailmentsor self-limiting disorders. Further study on predictive valuesof (combinations of) other signs and symptoms is necessary todevelop clinical recommendations.     

Knowledge, attitudes, and screening practices among older men regarding prostate cancer

OBJECTIVES: This study determined population-based rates of reported prostate cancer screening and assessed prostate cancer-related knowledge, attitudes, and screening practices among men in New York aged 50 years and older. METHODS: Two telephone surveys were conducted. One was included in the 1994 and 1995 statewide Behavioral Risk Factor Surveillance System interviews, and the other was a community-level survey that targeted Black men (African-American Men Survey). Prevalence estimates were computed for each survey, and prostate cancer screening practices were assessed with logistic regression models. RESULTS: Overall, fewer than 10% of the men in each survey perceived their prostate cancer risk to be high; almost 20% perceived no risk of developing the disease. Approximately 60% of the men in each survey reported ever having had a prostate-specific antigen (PSA) test. In both surveys, physician advice was significantly associated with screening with a PSA test or a digital rectal examination. Also, race was significantly associated with screening in the statewide survey. CONCLUSIONS: Many New York men appear to be unaware of risk factors for prostate cancer. However, a substantial percentage reported having been screened for the disease; physician advice may have been a major determining factor in their decision to be tested.     

Breaking bones,breaking budgets: a clinical and economic evaluation of a prospective,randomized, practice controlled,intervention study in the prevention of accidents in primary care

OBJECTIVE: This longitudinal study was designed to assess the effect of an educational training package for primary health care teams in accident prevention for older people, with reference to the incidence of accidents and their associated economic consequence. METHODS: Nineteen general practices in the West Midlands serving a population of 138 397 were allocated randomly at the practice level either to receive training or continue normal practice. Study data was collated from the initial telephone call, reporting an accident, to the surgery, advice/treatment given at the practice and/or the community, casualty, inpatient care, written correspondence to the patient's GP and any subsequent follow-up visits for accidents to people aged 65 years or older. RESULTS: One thousand, six hundred and sixty-six (8.2%) patients aged 65 years or older registered with the participating practices experienced one accident or more, costing the NHS pound 1.4 million. Extrapolated nationally, annual costs to the NHS for accidents to older people amount to pound 568 million. The educational package had no significant impact on the incidence of accidents. A paucity of general safety advice was given [48 (1.8%) occasions]. CONCLUSIONS: Budgets are being eroded and patients are suffering unnecessarily due to lack of accident prevention advice. This should be considered a priority within the primary health care team. Educational packages alone do not appear to be a cost-effective approach to accident prevention in primary care.